Hello Friends 👋
We have a new episode of Tech Tuesday for you with the amazing Dr. Anne Hansen. Dr. Hansen is the medical director of the Neonatal Intensive Care Unit at Boston Children's Hospital and the creator of the DreamWarmer, a non-electric infant warmer that supports kangaroo-mother-care. Information about Dr. Hanser and the device is available below. Enjoy!
Bio: Dr. Anne Hansen received her MD from Harvard Medical School and then went to Boston Children’s Hospital for her pediatric internship and residency. She stayed in Boston for her fellowship in Newborn Medicine at the combined program between Children’s, Beth Israel, and Brigham and Women’s Hospitals. She obtained her M.P.H. with a concentration in Clinical Effectiveness from Harvard School of Public Health. She joined the Harvard Medical School faculty in 1996 and is currently an Associate Professor of Pediatrics.
Dr. Anne Hansen has been the Medical Director of the Neonatal Intensive Care Unit at Boston Children’s Hospital since 2003. She has authored dozens of clinical guidelines, and is a chair or member of multiple unit based and hospital wide committees. She is a Fellow in the American Academy of Pediatrics. An acclaimed teacher, she is the recipient of the Merton Bernfield mentoring award, the Harvard Medical School Humanism Award, and the Tutor of the Year Award at Harvard Medical School. Dr. Hansen has published over 35 peer reviewed articles, 53 chapters and 8 books.
Her more recent work includes the development and testing of the Dream Warmer – a skin temperature heating pad that does not require electricity, is affordable, simple to use, and a safe and effective complement to Kangaroo Mother Care to prevent neonatal hypothermia.
The transcript of today's episode can be found below 👇
Welcome. Dr. N. Henson, thank you very much for joining us today on this Tech Tuesday episode. For people who are not familiar with who you are, you are the Medical Director of the neonatal intensive care unit at Boston Children's Hospital. Since 2003, you have a strong dedication to work in global health, and you are the creator of the dream warmer, which we'll talk about today. How are you this morning?
Unknown Speaker 1:28
I'm doing well. Thank you. I'm excited to be here.
Definitely. How's it going?
I'm I'm visiting my family. I'm on vacation, so I can't complain.
Okay. Dr. Henson, so for the people who are not familiar with what the dream warmer is, can you give us a brief introduction as to what is this device, what is it extend its intended uses and how innovative it is in the current market?
Speaker 3 1:57
Sure. It's actually an acronym. So it sounds for the durable, reusable, electricity free affordable mattress. And that pretty well describes it, it is a mattress that is. So it's intended to be a frugal technology. Which means that rather than having hand me down medical devices from rich countries to poor countries, this warmer was designed specifically to be appropriate for low and middle income countries. It is made up of several components, a backpack for carrying a thermos for heating it up an insulating sleeve for keeping it warm. And then the heart of it is an actual mattress, which is made of a very special kind of wax, which once melted stays exactly at skin temperature for about six hours. It's very easy to prepare, and to use and to clean. And it can be used in the facility setting or on transport or in the home setting.
You know, we have a we have a contest going for the best acronym of the year. And I think this this may be it because it literally describes what it does. But I love that that concept that you know, so much medical equipment is kind of this hand me down equipment where people have to troubleshoot how to make it work in their own environment. But this is really a self contained unit. If you look at it, you know, on the website, you understand exactly what it is right away. And everybody has all the parts that they need to make it work. Which I think you know, when we talk about getting resources, we really have to it's it's innovative to design things that are made for the places where they will be used. So I think that's incredible.
Yeah, and it's and it's and as we've often said, simplicity is the highest form of sophistication. And I think in this case, the dream warmer fits in in what looks like my daughter's school bag.
Unknown Speaker 4:06
So it's smaller even Yeah,
probably probably my daughter's bag has gotten bigger. And it's it seems extremely portable. And basically you can correct me if I'm wrong, but this the step by step instructions are quite easy. Basically, you use the thermos to to put boiling water and then you put this mattress with this special substance in it in the thermos for about 30 minutes. And then that mattress will remain at skin temperature it can be placed into the sleeve and then the baby can be wrapped in that in that sleeve. Now, I think one of the big things about the dream warmer that I was that I was struck by is that you really had a conscientious conscious idea to not disrupt skin to skin and kangaroo mother care. Can you tell us a little bit about how that concern and that and that product? Transition went into how you designed the device?
Speaker 3 5:04
Yes, thank you. That is the most important question that you could ask. And something that's top of mind for us with every single step of making the dream warmer. So in global health, everyone is aware that skin to skin care or kangaroo mother care is the absolute gold standard for an external heat source for small and preterm babies. And the dream warmer is intended only to complement KMC, never to compete with it, never to be considered an alternative to it, but just to complement it. So there's actually two ways that it can be used. Sometimes the littlest babies even when they're placed in perfect KMC positioning, that just does not supply enough heat, the babies get heat from the mother's chest to the front of the baby, but then the baby is losing a lot of heat out of the back of the baby, it's not really 360 degrees of external heat provision. So for those babies that dream warmer can be placed around the back of the baby. And then the dream warmer, and the baby and the mother are all wrapped in one blanket as a single system. And we found really great efficacy with the babies warming up well with that additional external heat source added to KMC. And then the other way that it can be used is what we call stand alone heat source. So if the mother is doing KMC, and it is adequate heat, but the mother needs to conduct an activity that's not compatible with KMC, such as bathing or cooking over a hot fire or any other activity where it's not safe to be doing KMC at the same time, or if she is ill postpartum. Or if the baby has a medical assessment or treatment that's very difficult to provide in KMC positioning, then the baby can be laid directly on the dream warmer kind with the way that we lay a baby on a warming table. And the baby can be then wrapped again in a blanket. And these babies maintain their heat in this positioning rather than being laid on a plane bed, at which point they get cold.
And this is something that you guys tested in a cluster randomized trial. That was, I think, published in 21. Were you really showed that the device is quite effective, both in maintaining you thermia, but also in avoiding hyperthermia, because obviously, that's always the concern is trying to remain within that window.
Speaker 3 7:38
Yes, we've actually published three papers. Now two were pilot studies. But the largest was the study that you just mentioned in The Lancet. And we've now tested it with over 1000 uses. And just to summarize all of that work, we've had zero instances in which the warmer was prepared, used or cleaned incorrectly, we've had zero instances of any burns or rashes, the rates of babies, having a temperature that was higher than the use or mid range is the same whether babies use the warmer or not. In fact, they have slightly lower rates of hyperthermia, when using the warmer. And that's because the warmer can only be 37 degrees, so it can't make babies hotter than that. And then in terms of efficacy, the data is kind of complex, because it depends on if we're looking at Babies who are hypothermic, or babies who are used thermic. But the mother is not going to be available for KMC. But putting all of that data together, that we have a 92% rate of babies either staying warm or becoming warm when they use the dream warmer.
And what is the obviously, the gestion gestational age that can be supported in different countries varies rates. So what did tell us a little bit about the kind of the lower end the youngest gestational age where this has been able to help support those babies, the highest risk babies?
Speaker 3 9:06
That's actually a difficult question to answer, because in most of his settings, where we are, the gestational age is not very accurate. We designed the studies to enable any baby who was cold to be able to use it. And so we have babies at all birth weights and therefore gestational ages who have used the warmer, I cannot tell you the lowest gestational age that a baby has ever been on the warmer because in global health work that actually is a hard number to come up with. So I apologize.
Sure. But certainly in terms of the the impact, and so many of these places, I mean, don't have access to to heat source at all, certainly not isolettes the the mothers are often acting as the isolette. And so this certainly we you know, we say kangaroo mother care, you know, but we think of that in a different way in this country potentially. And where, you know, we're trying to, we're just trying to integrate, reintegrate kangaroo mother care back into our general practice. But this is a mainstay of neonatal management in developing nations. But obviously there's we still struggle to keep babies warm, we struggled to keep babies warm, you know, in our level three fours here in the in the States, but this is a whole nother task to manage a continual heat source using the mother. So can you tell us a little bit about, you know, that experience, which is different, I think, too, when people think about it here in the state.
Speaker 3 10:43
Yes, that also is something that I've thought more and more about in the years that I've been working on this project. And I now have started to think about external heat provision as almost like the way that we think about providing oxygen to somebody who has pneumonia, we don't say if you have pneumonia, oh, well, we can give you oxygen six or eight hours a day, we understand it needs to be provided continuously. And so for external heat source for these small and preterm babies, if they are not in a thermal neutral environment, they are stealing calories that are intended for growth, especially brain growth, and they're really wasting them on staying warm. And so there's such compelling evidence that babies who have higher daily weight gain have better neurodevelopmental and physical outcomes. So that's not an area of controversy. And so anytime that a baby is a non in a non thermoneutral environment, and they're stealing calories to stay warm, we're really jeopardizing their neurodevelopmental outcome. When I look at MRIs of babies from 28 weeks to 38 weeks, I think that really is my patient, that is the organ that I am trying to support its development as normally as possible. And the brain needs to grow so much both in terms of size, but also complexity. And that's really a pre programmed brain growth. If that doesn't happen during that 10 weeks, they can't just happen when the baby is five years old. It needs to happen then. And so to optimize these babies neurodevelopmental outcome, we really need to support their growth. And part of supporting their growth requires keeping them in a thermoneutral environment.
I'm, I'm curious as to you have some information on the website, which we will link in the show notes, www dot global newborn.org. Very well designed website very comprehensive. And I am wondering if you could speak to us a little bit about the extent to which hyperthermia is an issue and what are some of the the impact of hyperthermia in low resource countries because it may not it's not always obvious that this is this is really a top priority because you people made me think other other issues are actually more more impacting more severely newborn. So I'm just curious, what was what what has your experience shown you in terms of the effects of hypothermia and newborns?
Speaker 3 13:24
Yeah, I love that question. Because coming from Boston, where we really don't think that much about the challenge of keeping babies warm. I never thought the whole area of hypothermia was all that interesting neonatology topic. But when I first started working in Rwanda, I was just shocked to see the rates of hypothermia and how difficult it was to keep these babies warm. They had a couple of incubators and warming tables. But as I said, they never worked very well. And we had lots of trouble training nurses to use both of those devices, there was a lot of trouble with cleaning them well. So we were concerned about babies getting infections in the incubators. And often nurses would put more than one patient in there. And then if the skin probe was on the back, the incubator would get way too hot. And we know hyperthermia is also really bad for you. It was just an enormous number of problems, that electricity would stop working, then there would be a big surge, and it would blow out all the incubators, and they're very expensive. So I just thought this just does not seem like the right approach. And I started looking at devices that are available that are more for the low and middle income country setting. And all of them had really significant problems. They were expensive. Many of them had attached fabrics, which for places that usually don't even have diapers really makes it a single patient device. And some of them were quite hard to prepare. And so this is where I thought I just feel like there's got to be a solution. We just can't have it that babies are cold in all of these countries not you know, medicine has come too far to have babies just being this cold all the time just because they happen to be born into a low income setting. And I'm sorry to get back to your question about the kinds of problems. First of all, I think, though, hypothermia is never listed on a death certificate, I don't think you'll think of this baby died of hypothermia. But it is estimated to contribute to about 40% of the babies who die in low and middle income countries. So just to give some sense of the size of the problem, there's about 2.5 million babies who die in low and middle income countries in their first month of life. And so 40% of that 2.5 million, that's about a million babies every year. So it's kind of a silent killer. People don't think of it as being the cause of death. But again, prematurity is the biggest cause of death for paid for pediatric patients under five years of age. And it's just an absolutely enormous problem. We also know that it contributes to low blood sugar poor growth, as I mentioned, respiratory problems, immunological problems, hematological problems, the whole body just doesn't function. Well, if it's not in a youth thermic range.
Yeah, that's what struck me when I saw it. I mean, this is it's not just about warmth, right, which we think of is kind of a nice adjunct, it's really life or death, right? It's life saving for, for these babies. We've come so far in the industrialized world that, you know, we thermo regulation is like one page when one paragraph right in our study, books, because because of how good our isolettes are, but this is really a huge global impact. And we talk about that on the podcast a lot recently, it feels like, you know, we spend hours agonizing about you know, we have the luxury of saying, you know, are we going to advance the feeds by 10 amounts, today, we're going to increase the tidal volume by, you know, one mL per kilo, what is that going to look like, when the bulk of neonatal deaths are happening in these low to middle income countries? About getting these two people? Can you tell us more about what is what is the cost? Like, how many times can they be reusable? Because it's a it's an incredible product?
Speaker 3 17:19
Yes, thank you. So my goal, in doing all of this was really to make this available for the world and not to have it be an academic product that ended up on some museum shelf. So once we did finish these pilot studies, where it was so promising, and the mothers and the nurses and everybody just loved it so much, I decided to make the leap to start a nonprofit, to manufacture and distribute the warmer. And that has been a whole saga, and certainly something I never learned about in medical school and has taken so much longer than I ever could have imagined. But we have now
we feel we feel your pain into the nonprofit down path. Yes, it resonates with us.
Speaker 3 18:02
Good. Well, I appreciate the empathy. But we now actually have finished a whole design for manufacturing process where we've identified a very robust plastic that goes around this wax that I've mentioned previously. And we are, we want it to last hundreds and hundreds of times because, again, working in these settings, having anything that finally gets all the way to a very rural low resource setting and then breaks is has huge disadvantages, including just disposing of a broken piece of medical equipment. So our goal is that at last 1000 cycles, it's actually not possible to test that because it just would take too long, so we're not going to know exactly how long it lasts until we actually have them in the field. But it seems to last many hundreds of cycles. And then also with just this design for manufacturing process, we've really improved both the aesthetics and the functionality of all of the different parts of it. One of the things we're most excited about is the thermos, which now has a built in timer on the lid. And the lid is designed to submerge the full mattress under the water. And it's designed to hold the exact volume of water that's needed exactly to melt the one kilogram of wax so that we aren't wasting any water which can also be a scarce resource. We have located a wonderful manufacturing partner in China. And we are going to be able to have full warming package with all of the components available for under $100. That's the manufacturing and the distribution and everything that goes into it. We have found a wonderful manufacturing partner in China. And they are actually manufacturing the first dream warmers right now. So this is a very Waiting time to be interviewed, we expect the first dream warmers to come off the conveyor belt in March 2023. And we expect that the cost of the warmer will be under $100. All in including all of the components and the shipping and the distribution and everything.
That's amazing. That's so exciting. And just to do some rough math, I mean, that means this could last 100 to 200 days, even if we got 50% of what what you said it would and I mean that that's one admission, multiple admissions, that's a that's a tremendous amount of value for for that price and the the ease of use.
And the NASA rover Opportunity was supposed to last 90 days and lasted for three years. So maybe
Speaker 3 20:48
my aspiration, but also just to clarify it is it's intended to be used across multiple patients, right. And so my hope would be it, you just wash it down and reuse it. So the hope is that it would be used Yes, for we hope yours.
Yeah. And on the website, we have, we have a nice table comparing it to other devices available out there. And I don't want to do comparison on the show, I don't want to I want to focus on the dream warmer, but you've managed to make this two to four times less expensive than other products out there, it lasts 10 times more than other products. It's it's the duration of warmth is is is six hours, and it's an it's at its highest. So my last question for you was when you're embarking on this journey, and maybe you hear at the time that there are other products out there, many innovators tend to say, oh, there's already something out there. I'm just gonna, that's it. Like, there's no point in me doing it. And so I'm just curious as to what was the mindset of saying no, actually, I feel like I could introduce something that would provide even more value. And can you walk us through your mindset, designing and pushing through the dream warmer, despite other competitors being out there?
Speaker 3 21:58
Thank you for that question. When I looked at the other options that were available at the time that were really intended to be used in the low resource setting, they had issues that for me, made it easy to try to come up with a better solution. One of the biggest issues is that the other products had attached fabrics, a kind of sleeping bag design, that for settings without washing machine, or as I said before, any diapers often was just not from a hygiene standpoint, not feasible. And then the other issue is that some of them were quite difficult to prepare. And when anything is using boiled water, it's very important in a nursery setting to be sure that the water is going to be safe. And so I have to give credit to Partners in Health and the Rwandan Ministry of Health and the wonderful engineers at UC Berkeley, that we designed a very wide based thermos that is very stable, and also added a thermal indicator to show very clearly when the mattress is safe and ready to use. And then the cost issue is really important. Because you know, again, I would love this to be available globally. And something that cost several $100 that would be used by a single family is not going to be used in the set, I'm looking at something that's really for the very poorest families and settings across the globe. And so I was really designing this specifically with that setting in mind.
It sounds like you've made it almost foolproof. So I think that's incredible. I have one last question. We're all overtime. We're always overtime. But this is not what you had intended. But like Ben said, sometimes the most simple products are the best products that have the most amount of use. Do you see this coming, circling back and being used in even high resource settings as we're trying to just do a better job is king of kangaroo care all together.
Speaker 3 24:02
I have thought about that many times, especially as we've sent our littlest babies down to the operating room, for example, and had them come back up cold. Our next dream warmer 2.0 is which we're designing now is a dream warmer that actually can be plugged in, it's really a standard heating pad, that will probably have to temperatures 37 degrees, and then a kind of boost temperature of 39 degrees for babies who are cold. And this is something that will be able to be plugged into the wall. And so we'll avoid all of the need for the hot water and the preparation. And so that might be able to be used here in the United States. We'll see that would be amazing.
That's awesome. That's awesome. Dr. Henson, thank you. Thank you so much for coming on the show today and for talking to us about the dream warmer for people who are interested all the links and all your information will be on the episode page. We can all find out more about The Dream warmer at WWW dot global newborn.org. We are going to look out for the amazing impact that remember will have on on mortality and on our most critically ill patients. Thank you so much for coming on the show today. It was it was a true pleasure.
Unknown Speaker 25:17
Thank you very much. It was a pleasure for me to
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